A specific plan with available lethal means indicates high, imminent risk.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with severe depression is started on therapy and medication. The nurse monitors most closely for increased suicide risk:
Answer: B. Suicide risk can rise as energy improves before mood fully lifts (early in treatment) — the client may gain the energy to act on suicidal thoughts. Increase observation during this period.
Question 2 of 5
A severely depressed client suddenly appears calm and energized after days of low mood. The nurse is MOST concerned about:
Answer: B. A sudden lift in a depressed client may mean they've decided on suicide and now have the energy to act. Increase observation and assess suicide risk directly.
Question 3 of 5
A client says, "There's no point to anything anymore." What is the nurse's BEST response?
Answer: B. Assess suicide risk directly and explore feelings: open-ended, here-and-now. Asking directly does not increase risk; false reassurance and changing the subject shut the client down.
Question 4 of 5
Which question best assesses immediate suicide risk?
Answer: B. Ask directly and specifically about a plan and means: 'Do you have a plan to harm yourself, and do you have access to do it?' Direct questions do not increase risk and identify danger.
Question 5 of 5
A client experiencing a manic episode is at greatest immediate risk for:
Answer: B. In mania, poor judgment, hyperactivity, and impulsivity risk injury, exhaustion, dehydration/poor nutrition, and risky behavior. Provide a low-stimulation environment, safety, and finger foods/fluids.
Keep the streak going with more questions like these, each with a full rationale.
What is suicide risk?
Risk rises with a specific plan, available means, prior attempts, hopelessness, and certain demographics. Direct questioning does NOT plant the idea; safety and one-to-one supervision are paramount. Memory aid SAD PERSONS includes Sex, Age, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness.
Key points to remember
- A specific plan with available lethal means indicates high, imminent risk.
- Prior attempts are the single strongest predictor of future suicide.
- Sudden calm or cheerfulness after deep depression can signal a decision to die.
- Giving away prized possessions and saying goodbye are warning behaviors.
- Risk increases as antidepressant treatment restores energy before mood improves.
- Hopelessness is more predictive of suicide than depressed mood itself.
Signs & symptoms
- Giving away possessions
- Sudden calm after depression
- Saying goodbye, hopelessness
Nursing priorities
- Ask directly about suicidal thoughts, plan, intent, and access to means.
- Place high-risk clients on continuous one-to-one observation and never leave them alone.
- Remove or secure dangerous items: sharps, belts, cords, medications, glass.
- Create a safe environment and document a no-self-harm safety plan and contract per protocol.
- Maintain close, frequent checks and stay with the client during high-risk periods.
Patient teaching
- Reach out to crisis lines or a trusted person and remove access to means when thoughts arise.
- Adhere to follow-up appointments and medications; report worsening thoughts immediately.
- Family should secure firearms and medications and maintain close support.
Red flags: report now
- Verbalized intent or plan with means is a psychiatric emergency requiring constant supervision.
- Never leave an actively suicidal client unattended, even to use the bathroom.
- A previously despondent client who suddenly appears peaceful and energized may be at imminent risk.
- Do not promise to keep suicidal disclosures secret; safety overrides confidentiality.
References
Clinical references for this topic
